Will Federalism Improve the U.S. Health Care System? Session IV: - - PowerPoint PPT Presentation

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Jan 27, 2023 155 likes •250 views

Will Federalism Improve the U.S. Health Care System? Session IV: Medicaid Diane Rowland, Sc.D. Executive Vice President, Kaiser Family Foundation May 22, 2019 Figure 1 Medicaids Framework Eligible Individuals are entitled to a defined set

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Will Federalism Improve the U.S. Health Care System?

Session IV: Medicaid

Diane Rowland, Sc.D. Executive Vice President, Kaiser Family Foundation May 22, 2019

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Figure 1

Medicaid’s Framework

Federal State Entitlement

Eligible Individuals are entitled to a defined set

f benefits

States are entitled to federal matching funds Sets core requirements on eligibility and benefits Flexibility to administer the program within federal guidelines

Partnership

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Figure 2

10 20 30 40 50 60 70 80 1972 1977 1982 1987 1992 1997 2003 2008 2015*

Managed Care Extended

Olmstead Decision

Medicaid’s Evolution

Millions of Medicaid Beneficiaries

Medicaid eligibility for women and children is expanded Medicaid ≠ Welfare ACA enacted HCBS waivers authorized SSI enacted Section 1115 waivers expand Medicaid eligibility SCHIP enacted Implementation of the ACA Medicaid expansion “Katie Beckett”

ption

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Figure 3

Medicaid’s Role

Health Insurance Coverage For 1 in 5 Americans State Capacity to Address Health Challenges

MEDICAID

Support for Health Care System and Safety-Net Assistance to 10 million Medicare Beneficiaries > 50% Long-Term Care Financing

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Figure 4

Federal Standards

Benefits Delivery Systems / Provider Payments Waivers Premiums / Cost Sharing Eligibility

Federal Rules/State Options

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Figure 5

Traditional Federal – State Financing

NOTE: FMAP percentages are in effect Oct. 1, 2019-Sept. 30, 2020. SOURCE: Federal Register, November 28, 2018 (Vol 83, No. 229)

50% (13 States) 50.1-59.9% (11 States) 60.0-69.9% (17 States)

FFY 2020 FMAP

70.0-77.0% (10 States including DC) WY WI WV WA VA VT UT TX TN SD SC RI PA OR OK OH ND NC NY NM NJ NH NV NE MT MO MS MN MI MA MD ME LA KY KS IA IN IL ID HI GA FL DC DE CT CO CA AR AZ AK AL

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Figure 6

SOURCE: Why Does Medicaid Spending Vary Across States: A Chart Book of Factors Driving State Spending, KCMU, November 2012.

Common Framework ↔ State Variation

Available Revenue: per capita income, total taxable

resources, tax collections

Budget and Policy Process: political affiliation of Governor

and legislature, legislative sessions, state budget process

MEDICAID SPENDING VARIES ACROSS STATES

Medicaid Policy Choices: eligibility levels, benefits,

payment and delivery system choices, long-term care delivery systems

Demand for Public Services: poverty, unemployment,

need for health services (coverage, age, disability, chronic conditions)

Health Care Markets: employer premiums, Medicare

spending per enrollee, primary care shortage areas, supply of providers and health facilities

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Figure 7